Faculty Bibliography

PURPOSE/OBJECTIVE:The purpose of the current study is to systematically review the current evidence in the literature to ascertain rates of return to play following ACLR with extra-articular augmentation (EA). METHODS:A literature search was performed based on the PRISMA guidelines. Studies were included if they evaluated and reported on return to play following ACLR + EA, case studies and review articles were excluded. The outcomes measured focused on 1) return to play, 2) return to play at the same or higher level, and 3) timing of return to play. Qualitative analysis and quantitative analysis were performed using SPSS. RESULTS:Overall, 19 studies met our inclusion criteria. Among those undergoing primary ACLR, 82.8%-100% were able to return to play, with 64%-100% able to return at the same/higher level of play. All professional athletes were able to return to play and 85.7%-100% able to return to the same level of pre-operative play. The mean time to return was 5-11 months in those undergoing primary ACLR + EA. Among those undergoing revision ACLR, 50-88.4% were able to return to play, with 41.5%-77.8% able to return at the same/higher level of play. None of the included 5 studies comparing rate of return to play between ACLR + EA or ACLR found a significant difference between them. However, among the 6 studies comparing rate of return to play at the same level ACLR + EA or ACLR, 2 studies found a significant difference in rate of return to play at the same/higher level in those undergoing ACLR + EA. CONCLUSION/CONCLUSIONS:ACLR + EA resulted in high levels of return to play in those undergoing either primary or revision ACLR. Additionally, comparative studies of patients undergoing primary ACLR with or without EA reported similar high rates of return to play.

BACKGROUND/UNASSIGNED:Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures used to treat a variety of conditions, with >500,000 procedures performed each year. PURPOSE/UNASSIGNED:To systematically review the randomized controlled trials (RCTs) on pain control after shoulder arthroscopy in the acute postoperative setting and to ascertain the best available evidence in managing pain after shoulder arthroscopy to optimize patient outcomes. STUDY DESIGN/UNASSIGNED:Systematic review and meta-analysis. METHODS/UNASSIGNED:A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies were included if they were RCTs evaluating interventions to reduce postoperative pain after shoulder arthroscopy: nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, oral medications, or other modalities. Meta-analyses and network meta-analyses were performed where appropriate. RESULTS/UNASSIGNED:< .05). No benefit was found in any of the studies evaluating subacromial infusions. CONCLUSION/UNASSIGNED:Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control. There is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use. However, we found no evidence to support the use of subacromial infusions or patient-controlled analgesia.

BACKGROUND/UNASSIGNED:It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates. PURPOSE/UNASSIGNED:To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR. METHODS/UNASSIGNED:The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. RESULTS/UNASSIGNED:There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category. CONCLUSION/UNASSIGNED:The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.

BACKGROUND:The purpose of this study was to perform a systematic review and meta-analysis of the current evidence in the literature to determine how arthroscopic Bankart repair (ABR) and remplissage compare with ABR alone and the open Latarjet procedure for anterior shoulder instability in patients with concomitant Hill-Sachs lesions. METHODS:A literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies comparing ABR and remplissage vs. ABR alone or the Latarjet procedure for anterior shoulder instability in patients with Hill-Sachs lesions were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). P < .05 was considered statistically significant. RESULTS:Twelve clinical trials were included. There was a significant difference between ABR plus remplissage and ABR alone in total recurrence rate (3.2% vs. 16.8%, P < .05) but not the rate of revision due to recurrence (1.7% vs. 8.5%, P = .06). There was no significant difference between the Latarjet procedure and ABR plus remplissage in total recurrence rate (7.0% vs. 9.8%, P = .39), total revision rate (3.7% vs. 5.7%, P = .41), and rate of revision due to recurrence (1.6% vs. 2.1%, P = .79). There was a significantly lower rate of complications with ABR and remplissage compared with the Latarjet procedure (0.5% vs. 8.6%, P = .003). CONCLUSION/CONCLUSIONS:In patients with Hill-Sachs lesions and subcritical glenoid bone loss, ABR with remplissage resulted in lower rates of recurrent instability compared with ABR alone while resulting in similar recurrence rates, as well as similar patient-reported outcomes, with lower morbidity and fewer complications, compared with the Latarjet procedure. LEVEL OF EVIDENCE/METHODS:Level III; Systematic Review.

INTRODUCTION/BACKGROUND:The purpose of the current study was to evaluate resident, fellow, and attending perspectives on the use of e-learning as part of orthopaedic surgery education. METHODS:A survey was created evaluating (1) overall attitudes toward e-learning, (2) multi-institutional e-learning/e-conferences, (3) national/regional e-conferences, and (4) future directions with e-learning. The survey was distributed to all the orthopaedic surgery residency program directors in the United States, and they were asked to circulate the survey to their program's faculty and trainees. RESULTS:A total of 268 responses were collected, including 100 attendings and 168 trainees. Overall satisfaction with e-learning compared with in-person learning was higher among trainees than attending faculty, with 51.4% of trainees favoring e-learning, as opposed to 32.2% of attendings (P = 0.006). Both groups felt they were more likely to pay attention with in-person learning (P = 0.89). During the COVID-19 pandemic, 85.7% of residents have used e-learning platforms to join a conference in their specialty of interest while off-service. Most attendings and trainees felt e-learning should play a supplemental role in standard residency/fellowship education, with a low number of respondents feeling that it should not be used (86.6% versus 84%, and 2.1% versus 0.6%, respectively, P = 0.28). CONCLUSION/CONCLUSIONS:E-learning has been an important modality to continue academic pursuits during the disruption in usual education and training schedules during the COVID-19 pandemic. Most trainees and attendings surveyed felt that e-learning should play a supplementary role in resident and fellow education moving forward. Although e-learning does provide an opportunity to hold multi-institutional conferences and makes participation in meetings logistically easier, it cannot fully replicate the dynamic interactions and benefits of in-person learning.

BACKGROUND:Traumatic anterior shoulder instability is a common clinical problem among athletic populations, with several surgical treatment options available. The optimal treatment remains undetermined. Currently the main current treatment options are the Latarjet procedure or open or arthroscopic Bankart repair. The purpose of this study was to network meta-analyze the recent evidence to ascertain if the open Latarjet procedure and open or arthroscopic Bankart repair result in lower recurrence rates and subsequent revision procedures. The results were ranked with the P-score. METHODS:A literature search was performed based on the PRISMA guidelines. Cohort studies comparing any of the open Latarjet procedure and open or arthrosopic Bankart repair for anterior shoulder instability were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. RESULTS:Twenty-nine studies with 2,474 patients were included. The open Latarjet procedure resulted in lower rates of recurrent instability and revisions due to recurrence compared to both open and arthroscopic Bankart repairs. The open Latarjet procedure resulted in the highest rate of return to play. However, the open Latarjet procedure also resulted in the highest complication rate. CONCLUSION/CONCLUSIONS:Our network meta-analysis found the open Latarjet procedure had the lowest recurrence rates, lowest revisions rates, and highest rates of return to play in the surgical treatment of anterior shoulder instability. However, the Latarjet procedure has been shown to result in a higher complication rate, which needs to be considered when deciding which stabilization procedure to perform.

PURPOSE/OBJECTIVE:This study systematically reviewed the literature for outcomes following revision surgery for a failed prior Latarjet procedure. METHODS:Two independent reviewers performed the literature search based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies in which the Latarjet procedure was performed as a revision procedure following failed prior shoulder instability surgery were included. Clinical outcomes analyzed were: 1. functional outcomes, 2. recurrent instability, 3. range of motion, and 4. COMPLICATIONS/RESULTS:Statistical analysis was performed using IBM SPSS. RESULTS:There were seven studies with 161 patients (162 shoulders) included. Four studies used a bone-block procedure, three used arthroscopic soft-tissue stabilization, and the mean follow-up was 49.8 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean average of 79.7, with 82.9% of patients having good to excellent outcomes. Return to play was possible for 73.8% of patients, with 64.2% of those returning to at least the same level of competition. The overall recurrence rate was 9.5%, with 3.6% and 5.9% experiencing recurrent dislocations and subluxations, respectively. The overall revision rate was 4.2%, with all patients undergoing revisions due to recurrence. There were no reported neurovascular complications. Instability arthropathy was reported in 43.3% of patients. CONCLUSION/CONCLUSIONS:Surgical management following a failed Latarjet procedure results in moderate rates of recurrent instability and has a low intraoperative and postoperative complication rate. Additionally, the results across all techniques appear similar, with no procedure being identified as the gold-standard in the literature. However, there was a concerning rate of instability arthropathy, which may be related to the failure of a bony procedure.